Healthcare Provider Details

I. General information

NPI: 1669147484
Provider Name (Legal Business Name): SUMIN HAHM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MANCHESTER RD STE D3
DERRY NH
03038-3067
US

IV. Provider business mailing address

25 EXECUTIVE DR UNIT 318
STONEHAM MA
02180-0041
US

V. Phone/Fax

Practice location:
  • Phone: 603-810-7218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1859159
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number05112
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN1859159
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: